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The analyst will evaluate healthcare utilization trends and claim data to develop cost-effective quality products and services. They are responsible for retrieving and organizing data to identify root causes of claim issues while working independently in a fast-paced environment.
The Senior Healthcare Claims Data Analyst will support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services. The ideal candidate retrieves, organizes and performs research/analysis on Medical Health Claim data primarily to identify root cause and is a proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently.
Candidate should have experience and knowledge across a breadth of health care claim domains. This includes Inpatient, Outpatient, SNF, ESRD, Rehab, Behavioral Health, Home Health, and PBM areas. Previous claim payment experience would also be beneficial and recommended. Understanding of Medical claim terminology and insurance terminology. Experience with provider billing practices, claim system limitations, and provider contracting terms are highly recommended. Experience in Pre Pay and Post Pay is recommended/encouraged as well.
*Salary Range for this role is: $93,900 - $154,200
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
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